Journal

PMG Conference 2019

The International Centre, Telford
15th - 17th July 2019

Shared decision-making and Personal Wheelchair Budgets

Rachael Bridge

Occupational Therapist

11 April 2018

Posture and Mobility Group held its 25th annual conference in Cardiff in 2017. Amongst those invited to speak were colleagues Lynne Peters and Lynn Jackson, who presented a prize-winning paper on Delivering a person-centred wheelchair service using shared decision making (Peters, Jackson & Howells, 2017).

Their paper was based on a joint working project between Halton & St Helen’s Wheelchair Service (Bridgewater Community Healthcare NHS Foundation Trust) and Advancing Quality Alliance (AQuA) team member, Brook Howells. The project sought to improve the person-centred approach when dealing with patient choice in identifying wheelchair equipment provision. This work is particularly timely given the current changes at a national level through the introduction of personal health budgets (PHBs).

In April 2017 the personal wheelchair budget (PWB) was launched by NHS England to replace the wheelchair voucher scheme. This is part of the bigger PHB model currently being rolled out by NHS England via local clinical commissioning groups (CCGs) (Buffery, 2017).

The NHS advises that the aim of PHBs is for people to “know how much money there is for [their] healthcare; have more say about [their] healthcare, [and they] agree the best way to spend the money with [their] local NHS team” (CHANGE, 2017).

The PWB model promotes “a more robust framework for person centred care and support planning. More control to people, their carers and families over the wheelchair provided. Greater clarity for wheelchair users about choices available including funding and what that should include” (NHS England, 2017).

The work completed with AQuA on shared decision making (SDM) provides a framework to guide the integration of this partnership model into our clinical practice. The introduction of PWBs provides the timing and opportunity for us to reflect as clinicians on our therapeutic relationships, and how we approach and structure interactions and interventions with our service users.

The concept of identifying a service user’s health and well-being goals is not new to an occupational therapist; however, it is encouraging to read NHS England promoting a model that looks to identify these goals and “how someone’s wheelchair can support them to be as independent as possible and meet those goals” (Buffery, 2017).

However, this new model does not bring with it any new funding. NHS England has advised each CCG to publish their local offer for PWBs by 2017/18 (Wigan Borough CCG, 2016). The webpage with PWB information for my local CCG was last updated in 2016; the information is not readily available on the website unless you know how to specifically search for it. To date, there is no mention of the PWB offer published on the website.

It is a time of unprecedented public scrutiny, when the nation’s press has wheelchair services under the spotlight perceiving service users being failed either by rejection of their referrals for failing to meet the “strict” eligibility criteria set out by CCGs, or by being offered “heavyweight basic wheelchairs” after a long wait (Ryan, 2017). Will the move to PWBs help address these failings, or widen the gap further between expectations and reality?

While NHS England advise wheelchair services to support independence “asking how the service user wants to live and what their goals are” (NHS England, 2017), they also outline in the Model service specification for Wheelchair and Posture Services (NHS England, 2017) what their commissioning priorities are: pressure ulcer reduction, prevention of falls, long-term management of health conditions, and the prevention of secondary deterioration.

At this juncture, it should be the role of the seating clinicians and therapists to bridge the gap between the client-centred goals of the PWB and the service priorities. One of the benefits of the PMG Conference is the collaboration of the private mobility/seating companies with the clinical staff of NHS and non-NHS backgrounds. The direct links between research, product development, trialling of equipment, and establishment of working relationships contributes towards achieving products which meet our clients’ needs, and are also within the thresholds of the NHS budgets.

The use of the shared decision-making framework enables us as clinicians to ensure we consider and discuss all options available to the client, even if out of the NHS budget range. The outcome of this allows the client to have control over their health decisions, and may increase the client’s awareness of the actual cost of their NHS wheelchair, which they may not have considered previously.